Prolactinoma pathophysiology

Prolactinoma Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

Prolactinoma may occur as part of a hereditary disorder called multiple endocrine neoplasia type 1 (MEN 1). A minority of prolactinomas are associated with Carney complex, McCune-Albright Syndrome, MEN like syndrome ( CKDN1B loss of function).

Pathophysiology

Prolactinoma may occur as part of a hereditary disorder called multiple endocrine neoplasia type 1 (MEN 1). A minority of prolactinomas are associated with:

• Multiple endocrine neoplasia type I (MEN I)
• Carney complex
• McCune-Albright Syndrome
• MEN like syndrome ( CKDN1B loss of function)

Familial pituitary adenomas

A pituitary adenoma may be part of a familial syndrome:

Syndrome	Gene	Notes
Multiple endocrine neoplasia I	MEN1	characterized by the 3 Ps: pituitary adenoma, parathyroid adenoma, pancreatic neuroendocrine tumour
MEN-1-like syndrome	CDKN1B	also known as Multiple endocrine neoplasia IV
Carney syndrome	PRKAR1A	other findings (mnemonic NAME): nevi, atrial myxoma, myxoid neurofibroma, ephelides (freckles)
Isolated pituitary adenoma	AIP	classically GH-producing adenoma - leads to acromegaly

Microscopic

Features:

• Loss of fibrous stroma.
  • The cells of a normal (anterior) pituitary are nested.

Notes:

• Smears very well.

Images

• 

  Pituitary adenoma - non-functioning. (WC/KGH)

• Extensive interstitial and perivascular fibrosis in a pituitary adenoma (WC/jensflorian)

  Extensive interstitial and perivascular fibrosis in a pituitary adenoma (WC/jensflorian)

• Pituitary adenoma - PRL producing, HE. Note the basophilic appearance of the cells (WC/jensflorian)

  Pituitary adenoma - PRL producing, HE. Note the basophilic appearance of the cells (WC/jensflorian)

• 

  Pituitary adenoma - PRL producing, HE. Extensive regressive changes after after dopamine agonist treatment (WC/jensflorian)

• Pituitary adenoma - PRL producing, Prolactin IHC (WC/jensflorian)

  Pituitary adenoma - PRL producing, Prolactin IHC (WC/jensflorian)

• Pituitary adenoma - HGH producing, HE. The cells have a slightly eosinophilic appearance (WC/jensflorian)

  Pituitary adenoma - HGH producing, HE. The cells have a slightly eosinophilic appearance (WC/jensflorian)

• Sparsely granulated adenoma - HGH producing. Note the numerous fibrous bodies in HE stain (WC/jensflorian)

  Sparsely granulated adenoma - HGH producing. Note the numerous fibrous bodies in HE stain (WC/jensflorian)

• Sparsely granulated adenoma - HGH producing. CK8 IHC highlighting fibrous bodies (WC/jensflorian)

  Sparsely granulated adenoma - HGH producing. CK8 IHC highlighting fibrous bodies (WC/jensflorian)

• Pituitary adenoma - TSH producing. HE stain showing pleomorphism (WC/jensflorian)

  Pituitary adenoma - TSH producing. HE stain showing pleomorphism (WC/jensflorian)

• Pituitary adenoma - TSH producing. TSH IHC can be heterogeneous (WC/jensflorian)

  Pituitary adenoma - TSH producing. TSH IHC can be heterogeneous (WC/jensflorian)

• 

  Pituitary adenoma - GH producing. (WC/KGH)

• Pituitary adenoma , HE. This gonadotropin producing adenoma has a papillary architecture (WC/jensflorian)

  Pituitary adenoma , HE. This gonadotropin producing adenoma has a papillary architecture (WC/jensflorian)

• Pituitary adenoma, IHC for FSH (WC/jensflorian)

  Pituitary adenoma, IHC for FSH (WC/jensflorian)

• Pituitary adenoma, IHC for LH (WC/jensflorian)

  Pituitary adenoma, IHC for LH (WC/jensflorian)

• Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian)

  Pituitary adenoma , ACTH producing. PAS-O-G stain showing basophilic adenoma cells (WC/jensflorian)

• Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian)

  Pituitary adenoma , ACTH producing. Strong ACTH IHC in this basophilic adenoma (WC/jensflorian)

www:

• Pituitary adenoma - crappy pictures (upmc.edu).
• Pituitary adenoma - case 2 - several images (upmc.edu).

Stains

• Reticulin - loss of reticulin between tumour cells.